“This research provides countries with a clear view of where progress is being made and where urgent action is needed,” said Gregory A. Roth, MD, MPH, senior author of the paper, Professor in the Division of Cardiology, and Director of the Program in Cardiovascular Health Metrics at the Institute for Health Metrics and Evaluation, University of Washington. “By targeting the most important and preventable risks, with effective policies and proven, cost-effective treatments, we can work to reduce premature mortality from non-communicable diseases. Each country can find reliable evidence and a kind of policy prescription for better cardiovascular health in our results.”
The updated report shows wide global, regional and national variation in CVD burden, even among countries with similar economies. Researchers estimated burden due to 376 diseases including CVD from 1990 to 2023 in 204 countries using all available data and statistical models. They identified potential drivers including population growth, population aging and risk factor exposure.
CVD remains the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD globally. There were 437 million CVD DALYs in 2023, with a 16-fold difference between the countries with the lowest and highest CVD DALY rates. This is a 1.4-fold increase from the 320 million CVD DALYs in 1990. CVDs were responsible for 19.2 million deaths in 2023, an increase from 13.1 million in 1990. The leading cardiovascular causes of DALYs were ischemic heart disease, intracerebral hemorrhage, ischemic stroke and hypertensive heart disease.
In 2023, 79.6% of all CVD DALYs globally were attributable to modifiable risk factors, which has increased globally by 97.4 million since 1990 largely due to population growth and aging. The top risk factors include metabolic, like high body mass index (BMI) and high fasting plasma glucose, followed by behavioral and environmental/occupational, like air pollution, lead exposure and higher temperatures. Metabolic, behavioral and environmental/occupational risk factors contributed to 67.3%, 44.9% and 35.8% of all CVD DALYs, respectively.
In contrast, decreases in exposure to tobacco and air pollution, specifically household air pollution, have counteracted some of the rising CVD burden.
Key Takeaways
The number of cardiovascular disease deaths worldwide has risen sharply, climbing from 13.1 million in 1990 to 19.2 million in 2023. Ischemic heart disease affected an estimated 240 million people in 2023, while lower extremity peripheral arterial disease impacted 122 million; stroke remained a leading cause of death and disability across all regions. Men had higher cardiovascular mortality rates than women in most regions, and risk increased steeply after age 50. High body mass index and high fasting plasma glucose were the fastest-growing metabolic contributors between 2018 and 2023, mirroring global trends in obesity and diabetes. In 2023, high systolic blood pressure was the leading contributor to CVD burden, followed by non-optimal diet; environmental risks including ambient and household air pollution, lead exposure, and non-optimal temperature; high LDL cholesterol; tobacco use; kidney dysfunction; low physical activity; and unsafe alcohol use. Ambient air pollution caused nearly 4 million cardiovascular deaths in 2023, with Oceania experiencing the highest rates despite global declines in exposure. Lead exposure also remains a major hazard in parts of Central Asia and North Africa. Tobacco use, poor diet, low physical activity, and high alcohol consumption continue to contribute significantly to the global toll, particularly for ischemic heart disease and atrial fibrillation. “The finding that CVD burden is substantially greater outside of the most developed settings even after accounting for differences in population age, remains among the most important messages of this analysis,” said Roth. “Our analysis shows wide geographic differences in CVD burden that can’t be explained by income level alone. Given this kind of variation, our findings offer the opportunity to tailor local health policies to target the most relevant risks for specific populations.”
Launched in 2020, the Global Burden of Cardiovascular Diseases Collaboration is an alliance between JACC, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and the National Heart, Lung, and Blood Institute. The 2025 publication includes data from 204 countries and territories, highlighting the leading global modifiable cardiovascular risk factors, their contribution to disease burden and recent prevention advancements.
“This report is a wake-up call: heart disease remains the world’s leading cause of death, and the burden is rising fastest in places least equipped to bear it,” said Harlan Krumholz, MD, FACC, JACC Editor-in-Chief and Harold H. Hines Jr Professor of Medicine, Yale University School of Medicine. "The good news is we know the risks and how to address them; if countries act now with effective health policies and systems, millions of lives can be saved.”
The report will publish to coincide with an event hosted at the 80th Session of the United Nations General Assembly (UNGA 80) titled “The Global Burden of CVD: New Insights to Drive Progress,” where JACC and IHME will present the latest findings and highlight the urgent need to prioritize heart health on the world stage.
To receive an embargoed copy of the report or to obtain media access to the UNGA event, contact Olivia Walther at owalther@acc.org. Visit JACC’s Global Burden of Cardiovascular Diseases webpage for additional resources and infographics.
The American College of Cardiology (ACC) is a global leader dedicated to transforming cardiovascular care and improving heart health for all. For more than 75 years, the ACC has empowered a community of over 60,000 cardiovascular professionals across more than 140 countries with cutting-edge education and advocacy, rigorous professional credentials, and trusted clinical guidance. From its world-class JACC Journals and NCDR registries to its Accreditation Services, global network of Chapters and Sections, and CardioSmart patient initiatives, the College is committed to creating a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at www.ACC.org or connect on social media at @ACCinTouch.
The ACC’s JACC Journals rank among the top cardiovascular journals in the world for scientific impact. The flagship journal, the Journal of the American College of Cardiology (JACC) — and specialty journals consisting of JACC: Advances, JACC: Asia, JACC: Basic to Translational Science, JACC: CardioOncology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Case Reports, JACC: Clinical Electrophysiology and JACC: Heart Failure — pride themselves on publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.
The Institute for Health Metrics and Evaluation (IHME) is an independent population health research organization based at the University of Washington School of Medicine. IHME works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health.
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